Abstract:
Although AIDS is now one of the leading causes of death of men aged 30 to 50 and cancer is the second leading cause of death in the elderly, very few studies have evaluated variations in the quality of medical care for patients (pts) with these diseases. Such information is needed if policy makers are to devise rational strategies for health care. This dissertation illustrates several important features of the health care system for pts with terminal diseases--AIDS and cancer. Specifically, with respect to AIDS, the data suggest that hospitals that have a high level of experience with AIDS are likely to use resources more efficiently and provide higher quality of medical care than hospitals with low levels of experience with AIDS. Similar results have been noted with respect to surgical diseases such as heart bypass surgery and prostate surgery; however, very few studies have shown similar results for pts with non-surgical diseases. Additional studies of men with prostate cancer clearly indicate that older men receive less care, even when management strategies include well-tolerated non-invasive tests and therapies. These results are also evident even when differences in extent of the cancer, comorbidities, and hospitals are controlled for. Older men appear to be treated with respect to chronologic, rather than physiologic age. This results in the use of less potentially curative therapies for older men; instead, they are treated more frequently with potentially toxic, yet palliative therapies. The policy implications of these studies may have relevance for the entire health care system. Health care systems where physicians and staff have high levels of experience with a disease may be necessary for both cost and quality reasons. Within these specialized systems, attention needs to be given to issues such as age bias which seem to systematically lead to poor quality of medical care. In this manner, pts with terminal diseases such as AIDS and cancer may have the best chance at receiving good quality medical care. (Full text available from University Microfilms International, Ann Arbor, MI, as Order No. AAD90-12735)
Keywords: Acquired Immunodeficiency Syndrome/*THERAPY Adult Age Factors Aged Human Male Middle Age Neoplasms/*THERAPY Prostatic Neoplasms/THERAPY *Quality of Health Care Terminal Care/*STANDARDS THESIS 901030
M90A0671
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